97TH GENERAL ASSEMBLY
State of Illinois
2011 and 2012
HB1661

 

Introduced 2/15/2011, by Rep. Patricia R. Bellock

 

SYNOPSIS AS INTRODUCED:
 
215 ILCS 170/52.5 new
305 ILCS 5/5-5.06 new

    Amends the Covering ALL KIDS Health Insurance Act and the Illinois Public Aid Code. Provides that beginning January 1, 2012, the physician fee schedule for the Covering ALL KIDS Health Insurance Program and for pediatric physician specialists under the medical assistance program must increase to become competitive with those of non-governmental, third-party health insurance programs. Provides that by January 1, 2015, the payment for a pediatric specialty physician service must not be lower than Medicare reimbursement in accordance with the Medicare payment localities for Illinois. Provides that the Department shall annually increase pediatric specialty physician payments under the provisions of the Act by an amount approximately equal to one-third of the difference between the actual rates available for such purposes on January 1, 2011 and the Medicare reimbursement rates effective on January 1, 2011. Makes other changes.


LRB097 08698 RPM 48827 b

 

 

A BILL FOR

 

HB1661LRB097 08698 RPM 48827 b

1    AN ACT concerning insurance.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Covering ALL KIDS Health Insurance Act is
5amended by adding Section 52.5 as follows:
 
6    (215 ILCS 170/52.5 new)
7    Sec. 52.5. Specialty physician care; fee schedule.
8    (a) Beginning January 1, 2012, the physician fee schedule
9for the Covering ALL KIDS Insurance Program must increase to
10become competitive with those of non-governmental, third-party
11health insurance programs. By January 1, 2015, the payment for
12a pediatric specialty physician service must not be lower than
13Medicare reimbursement in accordance with the Medicare payment
14localities for Illinois. Payment for services must be made
15within 30 days after receipt of a bill or claim meeting the
16requirements of the Department of Healthcare and Family
17Services.
18    (b) For payments made or authorized by the Department of
19Healthcare and Family Services, the Department shall annually
20increase pediatric specialty physician payments under
21subsection (a) by an amount approximately equal to one-third of
22the difference between the actual rates available for such
23purposes on January 1, 2011 and the Medicare reimbursement

 

 

HB1661- 2 -LRB097 08698 RPM 48827 b

1rates effective on January 1, 2011. If the General Assembly
2determines that resources are not available to fully fund the
3fee schedule for pediatric specialty physician care required by
4this subsection (b), then, until such time as the General
5Assembly determines that such funding is available, the
6Department shall increase any payment for physicians who
7provide pediatric specialty care services under the Covering
8ALL KIDS Health Insurance Program by an amount proportionately
9equivalent to any other increases for physicians, federally
10qualified health centers, rural health centers, or other
11non-institutional providers providing services to children for
12any services provided under this Act.
 
13    Section 10. The Illinois Public Aid Code is amended by
14adding Section 5-5.06 as follows:
 
15    (305 ILCS 5/5-5.06 new)
16    Sec. 5-5.06. Physician payments; pediatric specialty
17physician services.
18    (a) Notwithstanding any other provisions of this Article,
19beginning January 1, 2012, the physician fee schedule for
20pediatric physician specialists must increase to become
21competitive with those of non-governmental, third-party health
22insurance programs. By January 1, 2015, the payment for a
23pediatric specialty physician service must not be lower than
24Medicare reimbursement in accordance with the Medicare payment

 

 

HB1661- 3 -LRB097 08698 RPM 48827 b

1localities for Illinois. Payment for services must be made
2within 30 days after receipt of a bill or claim meeting the
3requirements of the Department of Healthcare and Family
4Services.
5    (b) For payments made or authorized by the Department of
6Healthcare and Family Services, the Department shall annually
7increase pediatric specialty physician payments under
8subsection (a) by an amount approximately equal to one-third of
9the difference between the actual rates available for such
10purposes on January 1, 2011 and the Medicare reimbursement
11rates effective on January 1, 2011. If the General Assembly
12determines that resources are not available to fully fund the
13fee schedule for pediatric specialty physician care required by
14this subsection (b), then, until such time as the General
15Assembly determines that such funding is available, the
16Department shall increase any payment for physicians who
17provide pediatric specialty care services under the medical
18assistance program by an amount proportionately equivalent to
19any other increases for physicians, federally qualified health
20centers, rural health centers, or other non-institutional
21providers providing services to children for any services
22provided under this Act.